Best Post-Acute Design 2017: Hospitality, Horses Meet Skilled Nursing

When David Freshwater, chairman of Watermark Retirement Communities, and David Barnes, the company’s president and CEO, set out to build a skilled nursing facility for the first time, they had decades of experience with SNF design to show them what was needed— and what to avoid.

The result was The Springs at Hacienda at the River in Tucson, Arizona, the winner of the 2017 Senior Housing News Architecture and Design Awards in the Skilled Nursing and Post-Acute Care category. With the look of a boutique hotel or resort, it’s designed to promote wellness “the second you walk in the building,” Barnes told SHN.

Hacienda at the River, which was completed in the first quarter of 2017, features a dozen long-term care (LTC) suites on the ground floor and 50 private and two semi-private guest suites on the second floor. It includes a studio for therapy spaces and the Acacia Cafe, where guests and residents can dine and which is open to the public. It’s part of a larger campus that also includes assisted living and memory care. Tucson-based Watermark is expected to operate more than 52 senior living communities in 21 states as of March 1.

SHN Awards Ad

The Springs at Hacienda residents also include horses, and while these are for memory care and assisted living programs, their presence on the campus adds to the unique ambience of the property.

“It had traditionally been a horse facility and before that a dude ranch, and even though it was right in the middle of the town, it sort of had that heritage and feel,” Freshwater told SHN. “We knew the property— my wife actually trained horses on the property when she was in college—so we had a long history of hanging out at this property, if you will, and when it came on the market it was fortuitous.”

The Concept

SHN Awards Ad

The equine presence, plus the arched opening, the look of adobe, the use of stone and wood, tree trunks supporting some of the canopies, and the Spanish Colonial elements of the architecture, creates the look “of a village that would be typical in Tuscon,” said Jeff Anderzhon, senior planner and design architect at Eppstein Uhen Architects and one of the awards judges.

This assessment was echoed by Eric Krull, executive vice president of THW Design and another judge.

“The reflection, feels, colors of the landscape, and that type of Spanish Colonial revival architecture tells me I live in Tucson, and I either used to ride those horses that they showed in the pictures or I lived on a ranch,” he said, painting a picture of how a prospective Hacienda resident might assess the place. “Even if I was in the urban neighborhoods, if I drive outside the city, I’m going to be driving right past those kind of shapes and forms. That kind of reflectivity fits right into people’s memories and history. When I’m 80 years old there in long-term care, I can connect the dots and I can feel safe and comfortable.”

Recommended SHN+ Exclusives

Patient comfort was a crucial first step in achieving the vision Watermark had for Hacienda at the River, Freshwater told SHN.

“We think the healing begins when you get to the front door, because you aren’t walking into a place that automatically you just don’t want to be in,” he said. “Because who wants to be in a nursing home?”

Barnes and Freshwater have spent the past three decades inheriting and acquiring existing buildings, and and so are familiar with how skilled nursing facilities were designed twenty or thirty years ago, Barnes explained.

The focus in the past was on the efficiency of the operation, with the result being a lot of so-called “spoke and wheel” facilities where residents are grouped around a nurse’s station, he said.

To combat the years of institutional thinking in SNF design, Watermark took a bold step: They hired CallisonRTKL in Los Angeles, which designed resorts and upscale housing, but had never before designed a nursing home.

RTKL was very familiar with Watermark, with whom the firm has been working since the early 2000s, according to Daun St. Amand, senior vice president in the Los Angeles office and leader of CallisonRTKL’s residential sector.

“Theoretically skilled nursing— it could be long-term, short-term— they’re homes, but they’re also a lot like hotels,” St. Amand told SHN. “You don’t have individual kitchens, of course, inside the units. So you start to think about the dining amenities, common areas, those places which are really the heart of the project.”

This slideshow requires JavaScript.

The Construction

The first concepts for Hacienda at the River were sketched on a napkin in a Starbucks in 2012, Jim Goebel, director of design and construction at Watermark, told SHN. The company got its development plan in March 2014, and purchased the land later that same year. Construction on the facility, which was contracted for about $21.06 million, began in July 2015.

Financing for the project included debt and equity, $14.5 million from the EB-5 program—which allows global investors in a project to get U.S. citizenship after five years—and perks from the city of Tucson in exchange for annexing the project from Pima County to the city.

The project was completed in the first quarter of 2017, for exactly what was budgeted, Freshwater said. But it wasn’t an easy ride. One of the most notable hurdles related to the decision to annex the project. It was a move that came with waived fees, building permits and certain entitlements.

It also nearly derailed the whole venture.

It was expected that annexation might cause major problems for Watermark, according to the experience of both the company and the consultants with which it was working, Freshwater said. This was because the city was prone to changing agreements and making difficult demands.

“I said we’re going to be different, because we’re going to hire the best law firms and we’re going to paper this thing to the Nth-degree,” he told SHN. “We’re going to have have what’s called a pre-annexation development agreement and it’s going to call for absolute approval of all our plans and specs.”

The annexation went through, Watermark went to its first meeting with the city—and was told to redesign the building, Freshwater said. A subsequent meeting went no better, with proposed compromises from Watermark on various aspects of the building rejected.

At the time the city raised objections, the facility was three months into its construction. But the battle with the city dragged on for months before Tucson changed its mind and accepted Watermark’s plan.

As for the building process itself, the site is somewhat constricted, at least in the component allotted to skilled nursing, St. Amand noted to SHN. Creating spaces for leisure time, wellness and social interaction, for instance, requires design flourishes, and including those on the amount of land available was a challenge, he said. But the firm drew from its hospitality experience to create a space that was compelling and avoided feeling institutional.

“When you look down our corridors, they’re fairly short but there’s interesting things happening on the way,” St. Amand said. “We have door drops where the doors recess, and so you create these rooms leading to the next room to the next room so you don’t feel this long corridor. It feels more intimate, more personal if you can divide that up.”

The views from the windows also add to the experience, particularly for skilled nursing patients. To the north are mountains, to the south a river, and sunsets to the west, St. Amand said.

“Essentially what we’re trying to do is create a healing environment, and the things that really create that or support are things like having a connection to nature,” he explained.

The Completion

Hacienda at the River is currently about 60% occupied, with assisted living filling 22 of 36 openings, memory care at 25 of 35, and skilled nursing at 30 of 52. The hospice division is full and LTC has about half of a dozen accommodations filled.

This matches expectations at this stage for the project, and though Hacienda at the River is in an early enough stage that it hasn’t yet returned the investment, its long-term prospects are strong, Freshwater said.

The facility has numerous relationships and links to the community, with partnerships ranging from the University of Arizona to local animal shelters. And with outpatient therapy and the cafe open to the public, the Hacienda at the River is becoming entrenched in the community.

It adds up to a unique experience for anyone who needs skilled nursing healing.

“I’ve been a jurist on the Senior Housing News design jury for four years now, and this is in my opinion one of the best if not the best examples of skilled nursing design,” Anderzhon told SHN. “It’s design that serves the residents needs really well, and as a subset of that, serves the need of the care provider really well.”

Written by Maggie Flynn

Companies featured in this article: